US20160007842A1 - Guidewire Navigation for Sinuplasty - Google Patents
Guidewire Navigation for Sinuplasty Download PDFInfo
- Publication number
- US20160007842A1 US20160007842A1 US14/792,823 US201514792823A US2016007842A1 US 20160007842 A1 US20160007842 A1 US 20160007842A1 US 201514792823 A US201514792823 A US 201514792823A US 2016007842 A1 US2016007842 A1 US 2016007842A1
- Authority
- US
- United States
- Prior art keywords
- guidewire
- distal end
- patient
- lumen
- coil
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 239000000835 fiber Substances 0.000 claims abstract description 35
- 230000005291 magnetic effect Effects 0.000 claims abstract description 34
- 210000003695 paranasal sinus Anatomy 0.000 claims abstract description 28
- 230000004044 response Effects 0.000 claims abstract description 16
- 238000000034 method Methods 0.000 claims description 28
- 238000004804 winding Methods 0.000 claims description 4
- 238000001356 surgical procedure Methods 0.000 description 21
- 210000003128 head Anatomy 0.000 description 8
- 238000010586 diagram Methods 0.000 description 6
- 210000003484 anatomy Anatomy 0.000 description 5
- 238000002595 magnetic resonance imaging Methods 0.000 description 5
- 238000011160 research Methods 0.000 description 4
- 239000000523 sample Substances 0.000 description 4
- 238000002604 ultrasonography Methods 0.000 description 4
- 238000003780 insertion Methods 0.000 description 3
- 230000037431 insertion Effects 0.000 description 3
- 230000015654 memory Effects 0.000 description 3
- 229910001000 nickel titanium Inorganic materials 0.000 description 3
- HLXZNVUGXRDIFK-UHFFFAOYSA-N nickel titanium Chemical compound [Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni] HLXZNVUGXRDIFK-UHFFFAOYSA-N 0.000 description 3
- 230000004913 activation Effects 0.000 description 2
- 210000004556 brain Anatomy 0.000 description 2
- 239000002131 composite material Substances 0.000 description 2
- 238000010276 construction Methods 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 239000011521 glass Substances 0.000 description 2
- 238000003384 imaging method Methods 0.000 description 2
- 210000001328 optic nerve Anatomy 0.000 description 2
- 238000002360 preparation method Methods 0.000 description 2
- 238000003325 tomography Methods 0.000 description 2
- 229910000619 316 stainless steel Inorganic materials 0.000 description 1
- 235000001674 Agaricus brunnescens Nutrition 0.000 description 1
- 229910000851 Alloy steel Inorganic materials 0.000 description 1
- 229910000684 Cobalt-chrome Inorganic materials 0.000 description 1
- 230000005355 Hall effect Effects 0.000 description 1
- RTAQQCXQSZGOHL-UHFFFAOYSA-N Titanium Chemical compound [Ti] RTAQQCXQSZGOHL-UHFFFAOYSA-N 0.000 description 1
- 238000005452 bending Methods 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000000988 bone and bone Anatomy 0.000 description 1
- 210000000845 cartilage Anatomy 0.000 description 1
- 239000010952 cobalt-chrome Substances 0.000 description 1
- 238000004891 communication Methods 0.000 description 1
- 238000005520 cutting process Methods 0.000 description 1
- 238000002059 diagnostic imaging Methods 0.000 description 1
- 229910003460 diamond Inorganic materials 0.000 description 1
- 239000010432 diamond Substances 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 239000003814 drug Substances 0.000 description 1
- 238000013129 endoscopic sinus surgery Methods 0.000 description 1
- 229920006333 epoxy cement Polymers 0.000 description 1
- 239000003302 ferromagnetic material Substances 0.000 description 1
- 239000003365 glass fiber Substances 0.000 description 1
- 238000005286 illumination Methods 0.000 description 1
- 238000002347 injection Methods 0.000 description 1
- 239000007924 injection Substances 0.000 description 1
- 230000002262 irrigation Effects 0.000 description 1
- 238000003973 irrigation Methods 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 230000003287 optical effect Effects 0.000 description 1
- 239000013307 optical fiber Substances 0.000 description 1
- 230000002093 peripheral effect Effects 0.000 description 1
- 230000008569 process Effects 0.000 description 1
- 238000012545 processing Methods 0.000 description 1
- 238000007674 radiofrequency ablation Methods 0.000 description 1
- 230000011218 segmentation Effects 0.000 description 1
- 238000005476 soldering Methods 0.000 description 1
- 229910052719 titanium Inorganic materials 0.000 description 1
- 239000010936 titanium Substances 0.000 description 1
- 238000012546 transfer Methods 0.000 description 1
- 230000009466 transformation Effects 0.000 description 1
- 238000012800 visualization Methods 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/06—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements
- A61B1/07—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements using light-conductive means, e.g. optical fibres
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/233—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the nose, i.e. nasoscopes, e.g. testing of patency of Eustachian tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/24—Surgical instruments, devices or methods, e.g. tourniquets for use in the oral cavity, larynx, bronchial passages or nose; Tongue scrapers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
- A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
- A61B5/062—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using magnetic field
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/09—Guide wires
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2051—Electromagnetic tracking systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2065—Tracking using image or pattern recognition
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2072—Reference field transducer attached to an instrument or patient
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A61B2090/306—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/361—Image-producing devices, e.g. surgical cameras
- A61B2090/3614—Image-producing devices, e.g. surgical cameras using optical fibre
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B2090/364—Correlation of different images or relation of image positions in respect to the body
- A61B2090/365—Correlation of different images or relation of image positions in respect to the body augmented reality, i.e. correlating a live optical image with another image
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3983—Reference marker arrangements for use with image guided surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
- A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/09—Guide wires
- A61M2025/09058—Basic structures of guide wires
- A61M2025/09083—Basic structures of guide wires having a coil around a core
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/09—Guide wires
- A61M2025/09108—Methods for making a guide wire
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/09—Guide wires
- A61M2025/0915—Guide wires having features for changing the stiffness
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/09—Guide wires
- A61M2025/09175—Guide wires having specific characteristics at the distal tip
- A61M2025/09183—Guide wires having specific characteristics at the distal tip having tools at the distal tip
Definitions
- a coil wound around the optic fiber and located within the lumen at the distal end, configured to generate a signal in response to a magnetic field interacting with the coil;
- the processor is configured to incorporate an indication of the location of the distal end into a displayed image of the patient.
- the processor is configured to recognize the nasal sinus in a received image of the patient, and to indicate the recognized nasal sinus in the displayed image.
- a guidewire having a distal end, configured to be inserted into proximity with a nasal sinus of a patient, the guidewire having a lumen;
- FIG. 2 is a schematic illustration of the head of a patient undergoing surgery with the system of FIG. 1 , according to an embodiment of the present invention
- FIGS. 5A and 5B are schematic diagrams of a guidewire, according to a further alternative embodiment of the present invention.
- a guidewire which is configured to be inserted into proximity with a nasal sinus of a patient, is formed with a lumen.
- An optic fiber that traverses the lumen is configured to illuminate the distal end of the guidewire.
- a coil is wound around the optic fiber, the coil being located within the lumen at the distal end of the guidewire. Winding the coil around the optic fiber ensures efficient use of space at the distal end of the guidewire.
- the coil generates a signal in response to a magnetic field interacting with the coil, and a processor receives the signal and evaluates the location of the distal end of the guidewire in response to the received signal.
- Elements of system 20 may be controlled by a system processor 40 , comprising a processing unit communicating with one or more memories.
- Processor 40 may be mounted in a console 50 , which comprises operating controls 51 that typically include a keypad and/or a pointing device such as a mouse or trackball.
- Console 50 also connects to other elements of system 20 , such as a proximal end 52 of catheter 24 .
- a physician 54 uses the operating controls to interact with the processor while performing the procedure, and the processor may present results produced by system 20 on a screen 56 .
- FIGS. 3A and 3B are schematic diagrams of guidewire 28 , according to an embodiment of the present invention.
- FIG. 3A is a schematic longitudinal section of the guidewire
- FIG. 3B is a schematic cross-section, taken along a line IIIB-IIIB, of the guidewire.
- Guidewire 28 comprises an outer coil 80 having an internal lumen 82 , and the coil is typically formed from non-ferromagnetic material, such as 316 stainless steel, titanium, cobalt-chrome, nitinol, and MP35N steel alloy, although the coil is not limited to these materials. In an embodiment, typical nominal external and internal diameters of the coil are 0.9 mm and 0.6 mm respectively.
- the guidewire has a distal end 30 and a proximal end 32 .
- coil 100 in guidewire 128 is not wound around optic fiber 90 . Rather, coil 100 , while being positioned within lumen 82 at the distal end of guidewire 128 , i.e. at distal end 130 , is separate from both core-wire 84 and optic fiber 90 . Signal levels from the coil are transferred to circuitry, described above with reference to FIGS. 3A , 3 B, enabling processor 40 to measure and record the signal levels. As is also described above, the transfer may be via wires 104 or wirelessly.
- the composite image, of the sinuses and the guidewire distal tip, may be displayed to physician 54 on screen 56 ( FIG. 1 ).
- physician 54 on screen 56 ( FIG. 1 ).
- FIG. 1 A more detailed description of such a use of a guidewire in real-time surgery is provided with respect to the flowchart of FIG. 6 , below.
- a “raw” image of the anatomy to be operated on is acquired.
- the raw image may comprise a CT image, an MRI image, or a US image, of the cranium. In some embodiments more than one such image is combined and the composite image produced, after registration of the combined images, is used as the raw image. Images are typically in a Digital Imaging and Communications in Medicine (DICOM) format.
- DICOM Digital Imaging and Communications in Medicine
- the 3D structures generated in step 302 are presented to physician 54 on a screen, herein assumed by way of example to be screen 56 .
- the physician uses operating controls 51 to manipulate the image so that the region to be operated on is clearly visible. To this end the physician may rotate, pan, and/or zoom the image, and/or generate one or more cross-sections of the image. In addition, the physician may vary the transparency and/or color of the different structures.
- the manipulation typically includes highlighting of a region that includes the region to be operated on. For the outflow tracts considered here, such highlighting may conveniently be achieved by applying a sinus outflow tract recognition algorithm to the manipulated image.
- the recognition may use an algorithm similar to that referred to above in step 302 , and/or may be implemented using the commercial software also referred to above.
- instruments to be used in the surgery are prepared so that they can be tracked during the surgery.
- the instruments include guidewire 28 , as described hereinabove, which can be tracked by system 20 using sensing coil 100 .
- physician 54 activates generators 24 to begin the instrument tracking process.
- the physician also displays one or more images, typically multiple image panels, on screen 56 .
- the images displayed typically include the real-time image formed by an endoscope used in the procedure, as well as the images prepared and generated in step 304 .
- the images displayed on screen 56 may be manipulated by the physician so as to improve the visibility of desired portions of the image, and so as to reduce “noise” in the presented image.
- Such manipulation typically includes the physician being able to render sections of the image, typically “outer” sections, to be at least partially transparent, so that inner sections of the image, including the indications of the distal tips of instruments used, including guidewire 28 , are more visible.
- the manipulation may include the physician applying “false” color to sections of the image representing specific anatomical structures that have been segmented in step 302 .
- images that may be presented on screen 56 include displays of planned surgical steps, paths to be taken by instruments, and structures in proximity to the structure being operated on. As stated above, such images are typically generated in image manipulation step 304 .
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- General Health & Medical Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Public Health (AREA)
- Heart & Thoracic Surgery (AREA)
- Veterinary Medicine (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Biophysics (AREA)
- Pathology (AREA)
- Physics & Mathematics (AREA)
- Pulmonology (AREA)
- Otolaryngology (AREA)
- Optics & Photonics (AREA)
- Radiology & Medical Imaging (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Hematology (AREA)
- Anesthesiology (AREA)
- Dentistry (AREA)
- Human Computer Interaction (AREA)
- Robotics (AREA)
- Neurosurgery (AREA)
- Surgical Instruments (AREA)
- Endoscopes (AREA)
- Media Introduction/Drainage Providing Device (AREA)
- Magnetic Resonance Imaging Apparatus (AREA)
Abstract
Description
- This application claims priority to U.S. Provisional Patent App. No. 62/022,607, Jul. 9, 2014, entitled “Guidewire Navigation for Sinuplasty,” the disclosure of which is incorporated by reference herein.
- This application also claims priority to U.S. Provisional Patent App. No. 62/052,391, filed Sep. 18, 2014, entitled “Guidewire Navigation for Sinuplasty,” the disclosure of which is incorporated by reference herein.
- Subject matter disclosed in this application was developed and the claimed invention was made by, or on behalf of, one or more parties to a joint research agreement that was in effect on or before the effective filing date of the claimed invention. The claimed invention was made as a result of activities undertaken within the scope of the joint research agreement. The parties to the joint research agreement include Biosense Webster (Israel) Ltd. and Acclarent, Inc.
- The present invention relates generally to equipment used in invasive surgery, and specifically to guidewires used in such surgery.
- Particularly in nasal sinus surgery, including sinuplasty, positioning of instruments during the surgery is critical due to the proximity of the sinuses to sensitive features such as the brain and the optic nerves. Various methods are known in the patent literature for facilitating positioning of such instruments, including positioning of guidewires.
- For example, U.S. Patent Application 2012/0265094, to Goldfarb et al., whose disclosure is incorporated herein by reference, describes a method that is useable to facilitate transnasal insertion and positioning of a guidewire. The method involves direct viewing of the guidewire via an endoscope.
- U.S. Patent Application 2012/0078118, to Jenkins et al., whose disclosure is incorporated herein by reference, describes an illuminating guidewire device. The disclosure states that the device may be employed to provide trans-illumination, and may facilitate visualization of target anatomy.
- Documents incorporated by reference in the present patent application are to be considered an integral part of the application except that, to the extent that any terms are defined in these incorporated documents in a manner that conflicts with definitions made explicitly or implicitly in the present specification, only the definitions in the present specification should be considered.
- An embodiment of the present invention provides apparatus, including,
- a guidewire having a distal end, configured to be inserted into proximity with a nasal sinus of a patient, the guidewire having a lumen;
- an optic fiber, traversing the lumen, configured to illuminate the distal end;
- a coil, wound around the optic fiber and located within the lumen at the distal end, configured to generate a signal in response to a magnetic field interacting with the coil; and
- a processor, configured to receive the signal and to evaluate a location of the distal end in response to the signal.
- In a disclosed embodiment the apparatus may also include one or more magnetic field generators fixedly positioned in proximity to the nasal sinus, configured to generate the magnetic field. Typically the processor is configured to register a location of the one or more magnetic field generators with the patient.
- In a further disclosed embodiment the apparatus also includes a core-wire, traversing the lumen, configured to stabilize the guidewire.
- In a yet further disclosed embodiment the processor is configured to incorporate an indication of the location of the distal end into a displayed image of the patient. Typically, the processor is configured to recognize the nasal sinus in a received image of the patient, and to indicate the recognized nasal sinus in the displayed image.
- There is further provided, according to an embodiment of the present invention embodiment of the present invention, a method, including,
- providing a guidewire having a distal end, the guidewire having a lumen;
- inserting an optic fiber, configured to illuminate the distal end, to traverse the lumen;
- winding a coil, configured to generate a signal in response to a magnetic field interacting with the coil, around the optic fiber;
- locating the coil within the lumen at the distal end;
- inserting the distal end of the guidewire into proximity with a nasal sinus of a patient; and
- receiving the signal and evaluating a location of the distal end in response to the received signal.
- There is further provided, according to an embodiment of the present invention embodiment of the present invention, apparatus, including,
- a guidewire having a distal end, configured to be inserted into proximity with a nasal sinus of a patient, the guidewire having a lumen;
- a core-wire, traversing the lumen, configured to stabilize the guidewire;
- a coil, encircling the core-wire and located within the lumen at the distal end, configured to generate a signal in response to a magnetic field interacting with the coil; and
- a processor, configured to receive the signal and to evaluate a location of the distal end in response to the signal.
- The present disclosure will be more fully understood from the following detailed description of the embodiments thereof, taken together with the drawings, in which:
-
FIG. 1 is a schematic illustration of a sinus surgery system, according to an embodiment of the present invention; -
FIG. 2 is a schematic illustration of the head of a patient undergoing surgery with the system ofFIG. 1 , according to an embodiment of the present invention; -
FIGS. 3A and 3B are schematic diagrams of a guidewire, according to an embodiment of the present invention; -
FIGS. 4A and 4B are schematic diagrams of a guidewire, according to an alternative embodiment of the present invention; -
FIGS. 5A and 5B are schematic diagrams of a guidewire, according to a further alternative embodiment of the present invention; and -
FIG. 6 is a flowchart of steps taken for performance of nasal sinus surgery, according to an embodiment of the present invention. -
-
- Overview
- In a typical sinuplasty procedure, a guidewire is inserted into the nasal sinus of a patient until the distal tip of the guidewire is positioned beyond a site within the sinus where the procedure is to be performed. Once the distal tip has been so positioned, a deflated balloon is slid along the guidewire until it reaches the procedure site. The balloon is then inflated to perform the sinuplasty procedure, the balloon inflation typically causing elements at the site, which are contacted by the balloon, to separate.
- Accurate positioning of the guidewire distal tip is extremely important, since the tip is typically in close proximity to critical features of the patient such as the brain, the eyes, and/or the optic nerves. Prior art sinuplasty systems track the distal tip by illuminating the tip, using an optic fiber in the guidewire, with visible light. A physician performing the procedure observes the light emitted from the patient's skin, and uses this observation to track the tip. However, the light originating at the distal tip and emitted from the skin has been dispersed and absorbed by elements such as blood, cartilage, and bone, so that the light visible to the physician does not allow the physician to accurately know the location of the tip.
- An embodiment of the present invention overcomes this problem by providing an alternative tracking method for the physician. A guidewire, which is configured to be inserted into proximity with a nasal sinus of a patient, is formed with a lumen. An optic fiber that traverses the lumen is configured to illuminate the distal end of the guidewire. A coil is wound around the optic fiber, the coil being located within the lumen at the distal end of the guidewire. Winding the coil around the optic fiber ensures efficient use of space at the distal end of the guidewire. The coil generates a signal in response to a magnetic field interacting with the coil, and a processor receives the signal and evaluates the location of the distal end of the guidewire in response to the received signal.
- The magnetic field used to interact with the coil may be generated from field generators that are placed in a frame clamped to the patient's head.
- The processor typically uses the evaluated location to superimpose an indication of the location of the distal tip on an image of the patient, and the superposition allows the physician to accurately track the position of the guidewire.
-
- System Description
- Reference is now made to
FIG. 1 , which is a schematic illustration of asinus surgery system 20, and toFIG. 2 , which is a schematic illustration of the head of a patient 22 undergoing surgery with the system, according to an embodiment of the present invention.System 20 is typically used during a sinuplasty procedure on a nasal sinus ofpatient 22. Prior to such a sinuplasty procedure, a set ofmagnetic field generators 24 are fixed to the head of the patient, typically by incorporating the generators into aframe 26 which is clamped to the patient's head. As is explained below, the field generators enable the position of aguidewire 28 that is inserted into the nasal sinus of the patient to be tracked. - Elements of
system 20, includinggenerators 24, may be controlled by asystem processor 40, comprising a processing unit communicating with one or more memories.Processor 40 may be mounted in aconsole 50, which comprises operating controls 51 that typically include a keypad and/or a pointing device such as a mouse or trackball.Console 50 also connects to other elements ofsystem 20, such as aproximal end 52 ofcatheter 24. Aphysician 54 uses the operating controls to interact with the processor while performing the procedure, and the processor may present results produced bysystem 20 on ascreen 56. -
Processor 40 uses software stored in a memory of the processor to operatesystem 20. The software may be downloaded toprocessor 40 in electronic form, over a network, for example, or it may, alternatively or additionally, be provided and/or stored on non-transitory tangible media, such as magnetic, optical, or electronic memory. -
Processor 40 uses the software, inter alia, to operate and calibratemagnetic generators 24. The generators are operated so as to transmit alternating magnetic fields of different frequencies into a region in proximity to frame 26. Prior to being placed on the patient, the generators in the frame may be calibrated by positioning a coil in the region in known locations and orientations relative to the frame. Signals are induced in the coil by the alternating magnetic fields, and the processor acquires and records the signals. The processor then formulates a calibration relationship between the locations and orientations of the coil, and the recorded signals for these locations and orientations. - Once the calibration relationship has been formulated, the frame may be placed on the patient's head. After placement, the frame is fixed in position, and registered with external features of the patient's head, for example by imaging the patient's head with the attached frame from a number of different angles. The frame registration also registers the magnetic field generators with the patient's external features. Alternatively or additionally, the registration may include placing a coil in one or more known locations and orientations with respect to the external features of the patient as well as with the frame. The Carto® system produced by Biosense Webster, of Diamond Bar, Calif., uses a system similar to that described herein for finding the location and orientation of a coil in a region irradiated by magnetic fields.
- In addition to registering with the patient's external features, the registration typically includes registration with an image of the patient's sinuses which has typically been acquired prior to a projected sinuplasty procedure. The image used may typically comprise a CT (computerized tomography), MRI (magnetic resonance imaging) or an ultrasound image, or a combination of such images. Thus
frame 26 is in registration with the patient's sinuses and with the patient's external features. -
FIGS. 3A and 3B are schematic diagrams ofguidewire 28, according to an embodiment of the present invention.FIG. 3A is a schematic longitudinal section of the guidewire, andFIG. 3B is a schematic cross-section, taken along a line IIIB-IIIB, of the guidewire.Guidewire 28 comprises anouter coil 80 having aninternal lumen 82, and the coil is typically formed from non-ferromagnetic material, such as 316 stainless steel, titanium, cobalt-chrome, nitinol, and MP35N steel alloy, although the coil is not limited to these materials. In an embodiment, typical nominal external and internal diameters of the coil are 0.9 mm and 0.6 mm respectively. The guidewire has adistal end 30 and aproximal end 32. - A tapered nitinol core-
wire 84 traverses the length of the lumen, the core-wire having adistal end 86 and aproximal end 88. The taper of the core-wire, at the distal end, is typically formed by centerless grinding. In a disclosed embodiment, a proximal diameter of the core-wire is in a range of 0.25 mm-0.35 mm and a distal diameter is between 0.01 mm and 0.015 mm. A typical length of the taper of the core-wire is 10 cm, while a typical length of the core-wire as a whole ranges between 40 cm and 80 cm. Core-wire 84 is typically used to stabilize the shape of the guidewire, by being attached in at least two locations, normally by soldering, toouter coil 80. The core-wire, when attached, provides flexural and torsional characteristics to the guidewire that, inter alia, prevent the guidewire from “winding up” when the user rotates the proximal end. The superelasticity of the nitinol allows the guidewire to undergo considerable bending while still being able to return to its unbent state. - In addition to core-
wire 84, anoptic fiber 90 is inserted intolumen 82 so as to traverse the length of the lumen. Adistal end 92 of the optic fiber is configured to be in proximity to atransparent lens 96, which is connected to, and which acts as a termination for,outer coil 80. A lamp (not shown in the figure) is coupled to aproximal end 98 of the optic fiber, and is operated byprocessor 40 so as to illuminatelens 96 with visible light.Optic fiber 90 may comprise a single strand of fiber. Alternativelyoptic fiber 90 may comprise a two or more strands of optical fibers. -
Optic fiber 90 is typically formed from plastic or glass. A plastic fiber typically has a lower transmissivity than a glass fiber, but may be less prone to breaking if the fiber is sharply bent. In oneembodiment optic fiber 90 comprises two plastic strands each having a diameter of 250 microns. In alternative embodimentsoptic fiber 90 comprises a single glass strand having a diameter of 150 microns or 200 microns. - Prior to insertion of the optic fiber into
lumen 82, a magneticfield sensing coil 100 is wound arounddistal end 92 ofoptic fiber 90, so that after insertion the sensing coil is positioned atdistal end 30 ofguidewire 28. The sensing coil thus has an internal diameter corresponding to the external diameter ofoptic fiber 90. In some embodiments there is a small gap, typically approximately 25 microns, between the internal circumference of the sensing coil and the external circumference of the optic fiber. In oneembodiment coil 100 has an external diameter of 0.45 mm, although other embodiments may have coil external diameters larger or smaller than 0.45 mm. The two ends ofcoil 100 are typically connected by conductingwires 104 which traverse the length oflumen 82. The conducting wires are connected to circuitry, typically inconsole 50, which is configured to enableprocessor 40 to measure and record signal levels generated by the two ends ofcoil 100. Alternatively, the signal levels may be at least partially conveyed wirelessly to the circuitry. -
FIGS. 4A and 4B are schematic diagrams of aguidewire 128, according to an alternative embodiment of the present invention.FIG. 4A is a schematic longitudinal section ofguidewire 128, andFIG. 4B is a schematic cross-section, taken along a line IVB-IVB, of the guidewire.Guidewire 128 has a distal end 130 and aproximal end 132. Apart from the differences described below, the operation ofguidewire 128 is generally similar to that of guidewire 28 (FIGS. 3A and 3B ), and elements indicated by the same reference numerals in bothguidewires guidewire 28 insystem 20. - In contrast to guidewire 28,
coil 100 inguidewire 128 is not wound aroundoptic fiber 90. Rather,coil 100, while being positioned withinlumen 82 at the distal end ofguidewire 128, i.e. at distal end 130, is separate from both core-wire 84 andoptic fiber 90. Signal levels from the coil are transferred to circuitry, described above with reference toFIGS. 3A , 3B, enablingprocessor 40 to measure and record the signal levels. As is also described above, the transfer may be viawires 104 or wirelessly. -
Guidewire 128 also comprises tapered, core-wire 84, extending the length oflumen 82. As forguidewire 28, core-wire 84 acts to stabilizeguidewire 128. -
FIGS. 5A and 5B are schematic diagrams of aguidewire 228, according to a further alternative embodiment of the present invention.FIG. 5A is a schematic longitudinal section ofguidewire 228, andFIG. 5B is a schematic cross-section, taken along a line VB-VB, of the guidewire.Guidewire 228 has adistal end 230 and aproximal end 232. Apart from the differences described below, the operation ofguidewire 228 is generally similar to that of guidewire 28 (FIGS. 3A and 3B ), and elements indicated by the same reference numerals in bothguidewires guidewire 28 insystem 20. - In
guidewire 228coil 100 is configured to encircledistal end 86 of core-wire 84. Typically, an inside diameter ofcoil 100 is larger than an external diameter of core-wire 84, and the coil may be fixed by any convenient means, such as epoxy cement, (not shown in the figure) to the core-wire. Signal levels generated by the coil are transferred toprocessor 40, substantially as described above forguidewires guidewire 228 there is an optic fiber, similar in functionality and characteristics tooptic fiber 90, located in and traversing the length oflumen 82. Alternatively, as illustrated in the figure, there is no optic fiber inguidewire 228. - In a sinuplasty procedure, a guidewire such as
guidewire coil 100 acquires signals from the coil, whilegenerators 24 are transmitting their magnetic fields. The processor applies the calibration relationship referred to above to the signals, and together with the registration also described above finds the location and orientation of the coil. An indication of the location and orientation of the coil, i.e., of the distal tip of the guidewire, may be overlaid onto a registered image of the patient's sinuses, the image having typically been acquired prior to the procedure. The image used may typically comprise a CT (computerized tomography), MRI (magnetic resonance imaging) or an ultrasound (US) image, or a combination of such images. - The composite image, of the sinuses and the guidewire distal tip, may be displayed to
physician 54 on screen 56 (FIG. 1 ). A more detailed description of such a use of a guidewire in real-time surgery is provided with respect to the flowchart ofFIG. 6 , below. -
FIG. 6 is a flowchart of steps taken for performance of nasal sinus surgery, according to an embodiment of the present invention. The surgery is assumed by way of example to be performed on the ostium and outflow tract of a peripheral sinus, but those having ordinary skill in the art will be able to adapt the description, mutatis mutandis, for other types of sinus surgery. - The steps of the flowchart assume that the distal tip of a guidewire such as one of those described hereinabove is tracked in real-time during the course of the surgery, by the magnetic tracking system described above. For clarity, in the flowchart
description hereinbelow guidewire 28 is assumed to be used, and those having ordinary skill in the art will be able to modify the description for the use of other guidewires, such asguidewire 128 orguidewire 228. - The distal tips of other instruments used during the surgery, such as the distal tip of an endoscope, may also be tracked by the magnetic tracking system by incorporating respective coils into the instrument distal tips for flexible or rigid instruments, as is known in the art. Such instruments, which may typically be used for rhinological surgery, including Functional Endoscopic Sinus Surgery (FESS) and balloon-assisted FESS, i.e., balloon sinuplasty, are commercially available.
- For rigid instruments, the tracking coil may alternatively be positioned in a proximal portion of the instrument, provided that the magnetic tracking system has been programmed to make the spatial adjustments required to convert the signals received from the coil. Such a method for tracking is also known in the art.
- In a preparatory step 300 a “raw” image of the anatomy to be operated on is acquired. The raw image may comprise a CT image, an MRI image, or a US image, of the cranium. In some embodiments more than one such image is combined and the composite image produced, after registration of the combined images, is used as the raw image. Images are typically in a Digital Imaging and Communications in Medicine (DICOM) format.
- In a
first analysis step 302, the raw image is analyzed to isolate sino-nasal structures in the image. The analysis applies recognition algorithms to point clouds derived from the images so as to generate the different structures. The algorithms are used to segment the image, and to form the segmented sections into three-dimensional (3D) structures. - The algorithms used may be based on “seeded region growing” algorithms such as those described in the paper “Comparison of 3D Segmentation Algorithms for Medical Imaging,” by Hakan et al., published in the Twentieth IEEE International Symposium on Computer-Based Medical Systems, 2007, CBMS '07, which is incorporated herein by reference. Alternatively or additionally, the recognition referred to herein may be implemented using commercially available software, such as the OsiriX 6.5 image processing software produced by Pixmeo of Bernex, Geneva, Switzerland, or the Mimics software produced by Materialise Inc. of Leuven, Belgium.
- The points within the 3D structures generated have coordinates which enable any given structure to be transformed. For example, a given structure may be translated or rotated, or other types of transformation may be applied to the structure.
- In an
image manipulation step 304, the 3D structures generated instep 302 are presented tophysician 54 on a screen, herein assumed by way of example to bescreen 56. The physician uses operating controls 51 to manipulate the image so that the region to be operated on is clearly visible. To this end the physician may rotate, pan, and/or zoom the image, and/or generate one or more cross-sections of the image. In addition, the physician may vary the transparency and/or color of the different structures. The manipulation typically includes highlighting of a region that includes the region to be operated on. For the outflow tracts considered here, such highlighting may conveniently be achieved by applying a sinus outflow tract recognition algorithm to the manipulated image. The recognition may use an algorithm similar to that referred to above instep 302, and/or may be implemented using the commercial software also referred to above. - Other images that may be generated in
step 304 include displays of planned surgical steps, paths to be taken by instruments, and structures in proximity to the outflow tracts. - Step 304 concludes an image preparation phase that is implemented prior to performance of the nasal sinus surgery. The following steps of the flowchart describe actions that may be taken during the surgery.
- In an instrument preparation step 306, instruments to be used in the surgery are prepared so that they can be tracked during the surgery. The instruments include
guidewire 28, as described hereinabove, which can be tracked bysystem 20 usingsensing coil 100. - The instruments typically also include an endoscope, and may also include one or more flexible instruments and one or more catheters. The instruments may further include, but are not limited to, one or more of the following: Grasping forceps, cutting forceps, including Blakesly forceps and Blakesly throughcutting forceps, irrigation cannulae, suction cannulae, including Frazier and Yankauer suction cannulae, balltipped probe, sinus seeker, Freer elevator, Coddle elevator, other elevators, J-curettes or other curettes, punches, including mushroom punches, injection needles, needle drivers, monopolar or bipolar electrocautery probes, RF ablation probes, laser-energy transmitting probes, powered or manual microdebriders, shavers, drills, or burrs.
- Any instruments that are to be used may have positional sensors, herein assumed to comprise electromagnetic positional sensors, attached to the instruments. Such sensors typically comprise coils similar to
coil 100, and may be configured to be tracked bysystem 20, using magnetic fields fromgenerators 24 to induce tracking signals in the coils. Alternatively, the sensors may be configured to use the Hall effect to generate the tracking signals. In the case of rigid instruments, the sensors may be mounted on a proximal portion of the instrument in a known fixed spatial relation with the instrument distal portion. If the instrument is flexible, the sensor is mounted on the distal portion of the instrument. - In some cases, a sensor may be built into an instrument at the time of manufacture. In other instances, it may be desirable to attach one or more sensors to an instrument prior to use of that instrument in surgery. A method for performing such attachment is described in U.S. Pat. No. 8,190,389 and U.S. Patent Publication 2012/0245456, both entitled “Adapter for Attaching Electromagnetic Image Guidance Components to a Medical Device,” which are incorporated herein by reference.
- In a final real-
time procedure step 308physician 54 activatesgenerators 24 to begin the instrument tracking process. The physician also displays one or more images, typically multiple image panels, onscreen 56. The images displayed typically include the real-time image formed by an endoscope used in the procedure, as well as the images prepared and generated instep 304. - An indication of the location and orientation of the endoscope distal end may be overlaid, in registration, on the outflow tracts image generated in
step 304. Similarly, an indication of the location and orientation of the distal tip ofguidewire 28 may also be overlaid, in registration, with the outflow tracts image. - As other instruments are introduced into the patient, their location and orientation may also be overlaid on the outflow tracts image.
- The endoscope image referred to above may have superimposed upon it the image of the outflow tracts generated in
image manipulation step 304, as well as one or more images of other structures that may have been generated in the image manipulation step. - Typically, the images displayed on
screen 56 may be manipulated by the physician so as to improve the visibility of desired portions of the image, and so as to reduce “noise” in the presented image. Such manipulation typically includes the physician being able to render sections of the image, typically “outer” sections, to be at least partially transparent, so that inner sections of the image, including the indications of the distal tips of instruments used, includingguidewire 28, are more visible. Alternatively or additionally, the manipulation may include the physician applying “false” color to sections of the image representing specific anatomical structures that have been segmented instep 302. - Because the location and orientation of the distal tip of
guidewire 28 are known in real-time, cross-sections or slices of the anatomy in proximity to the distal end of the guidewire may be generated and displayed onscreen 56 bysystem 20. For example, a cross-section of the anatomy ahead of the guidewire distal tip may be displayed. - Other images that may be presented on
screen 56 include displays of planned surgical steps, paths to be taken by instruments, and structures in proximity to the structure being operated on. As stated above, such images are typically generated inimage manipulation step 304. - While the images on
screen 56, including the different image panels may be actuated and/or adjusted usingcontrols 51, in someembodiments physician 54 uses voice activation, or another non-tactile method of activation, for such actuation or adjustment. - It will be appreciated that the embodiments described above are cited by way of example, and that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art.
Claims (18)
Priority Applications (11)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/792,823 US10772489B2 (en) | 2014-07-09 | 2015-07-07 | Guidewire navigation for sinuplasty |
CA2954407A CA2954407A1 (en) | 2014-07-09 | 2015-07-08 | Guidewire navigation for sinuplasty |
CN202110706710.6A CN113476719A (en) | 2014-07-09 | 2015-07-08 | Guidewire manipulation for sinus dilation |
CN201580037449.8A CN106488736A (en) | 2014-07-09 | 2015-07-08 | Seal wire for nasal sinuses dilatation manipulates |
AU2015287957A AU2015287957B2 (en) | 2014-07-09 | 2015-07-08 | Guidewire navigation for sinuplasty |
ES15739734T ES2751274T3 (en) | 2014-07-09 | 2015-07-08 | Navigation guide for sinuplasty |
KR1020177003221A KR20170035931A (en) | 2014-07-09 | 2015-07-08 | Guidewire navigation for sinuplasty |
EP15739734.0A EP3166678B1 (en) | 2014-07-09 | 2015-07-08 | Guidewire navigation for sinuplasty |
PCT/US2015/039501 WO2016007591A1 (en) | 2014-07-09 | 2015-07-08 | Guidewire navigation for sinuplasty |
JP2017501024A JP6588076B2 (en) | 2014-07-09 | 2015-07-08 | Guidewire navigation for sinusplasty |
IL249786A IL249786B (en) | 2014-07-09 | 2016-12-27 | Guidewire navigation for sinuplasty |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US201462022607P | 2014-07-09 | 2014-07-09 | |
US201462052391P | 2014-09-18 | 2014-09-18 | |
US14/792,823 US10772489B2 (en) | 2014-07-09 | 2015-07-07 | Guidewire navigation for sinuplasty |
Publications (2)
Publication Number | Publication Date |
---|---|
US20160007842A1 true US20160007842A1 (en) | 2016-01-14 |
US10772489B2 US10772489B2 (en) | 2020-09-15 |
Family
ID=53716584
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US14/792,823 Active 2037-10-09 US10772489B2 (en) | 2014-07-09 | 2015-07-07 | Guidewire navigation for sinuplasty |
Country Status (10)
Country | Link |
---|---|
US (1) | US10772489B2 (en) |
EP (1) | EP3166678B1 (en) |
JP (1) | JP6588076B2 (en) |
KR (1) | KR20170035931A (en) |
CN (2) | CN113476719A (en) |
AU (1) | AU2015287957B2 (en) |
CA (1) | CA2954407A1 (en) |
ES (1) | ES2751274T3 (en) |
IL (1) | IL249786B (en) |
WO (1) | WO2016007591A1 (en) |
Cited By (28)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20160372252A1 (en) * | 2015-06-18 | 2016-12-22 | Biosense Webster (Israel) Ltd. | Tracking sensor |
ES2608861A1 (en) * | 2016-06-30 | 2017-04-17 | Universidad De Málaga | Device, system and procedure to obtain computational rhinomanometric curves (Machine-translation by Google Translate, not legally binding) |
CN107684660A (en) * | 2016-08-04 | 2018-02-13 | 韦伯斯特生物官能(以色列)有限公司 | Sacculus positioning in nasal sinus expansion operation |
EP3300679A1 (en) * | 2016-09-14 | 2018-04-04 | Biosense Webster (Israel), Ltd. | Wireless tool for treatment of ear, nose, throat |
EP3315163A1 (en) | 2016-10-25 | 2018-05-02 | Biosense Webster (Israel), Ltd. | Guidewires having improved mechanical strength and electromagnetic shielding |
JP2018079312A (en) * | 2016-11-01 | 2018-05-24 | バイオセンス・ウエブスター・(イスラエル)・リミテッドBiosense Webster (Israel), Ltd. | Rigid ENT tool |
EP3395282A1 (en) | 2017-04-25 | 2018-10-31 | Biosense Webster (Israel) Ltd. | Endoscopic view of invasive procedures in narrow passages |
US10188465B2 (en) | 2015-08-26 | 2019-01-29 | Biosense Webster (Israel) Ltd. | Automatic ENT surgery preplanning using a backtracking maze problem solution |
US10463242B2 (en) | 2014-07-09 | 2019-11-05 | Acclarent, Inc. | Guidewire navigation for sinuplasty |
US20200054282A1 (en) * | 2018-08-14 | 2020-02-20 | Biosense Webster (Israel) Ltd. | Guidewire with an integrated optical fiber |
EP3632360A1 (en) | 2018-10-04 | 2020-04-08 | Biosense Webster (Israel) Ltd. | Automatic probe reinsertion |
EP3643265A1 (en) | 2018-10-26 | 2020-04-29 | Biosense Webster (Israel) Ltd. | Loose mode for robot |
US10646201B2 (en) | 2014-11-18 | 2020-05-12 | C. R. Bard, Inc. | Ultrasound imaging system having automatic image presentation |
EP3673854A1 (en) | 2018-12-28 | 2020-07-01 | Biosense Webster (Israel) Ltd. | Correcting medical scans |
US10722306B2 (en) | 2015-11-17 | 2020-07-28 | Biosense Webster (Israel) Ltd. | System for tracking guidewire with ray tracing capability |
US10772489B2 (en) | 2014-07-09 | 2020-09-15 | Acclarent, Inc. | Guidewire navigation for sinuplasty |
EP3718497A1 (en) | 2019-04-04 | 2020-10-07 | Biosense Webster (Israel) Ltd. | Medical instrument with coagulation |
EP3718493A1 (en) | 2019-04-04 | 2020-10-07 | Biosense Webster (Israel) Ltd. | Medical instrument identification |
EP3725251A1 (en) | 2019-04-18 | 2020-10-21 | Biosense Webster (Israel) Ltd. | Grasper tool with coagulation |
WO2020234668A1 (en) | 2019-05-23 | 2020-11-26 | Biosense Webster (Israel) Ltd. | Probe with radiopaque tag |
US10905396B2 (en) | 2014-11-18 | 2021-02-02 | C. R. Bard, Inc. | Ultrasound imaging system having automatic image presentation |
EP3791786A1 (en) | 2019-09-16 | 2021-03-17 | Biosense Webster (Israel) Ltd | Flexible shielded position sensor |
CN112804940A (en) * | 2018-10-04 | 2021-05-14 | 伯恩森斯韦伯斯特(以色列)有限责任公司 | ENT tool using camera |
WO2021181209A1 (en) | 2020-03-09 | 2021-09-16 | Biosense Webster (Israel) Ltd. | Finding roll angle of distal end of deflectable or non-deflectable invasive medical instrument |
WO2022003444A1 (en) | 2020-06-29 | 2022-01-06 | Biosense Webster (Israel) Ltd. | Efficient automatic finding of minimal ear-nose-throat (ent) path for probe |
US20220061922A1 (en) * | 2020-08-25 | 2022-03-03 | Acclarent, Inc. | Apparatus and method for posterior nasal nerve ablation |
CN115300130A (en) * | 2022-10-12 | 2022-11-08 | 吉林大学第一医院 | Adjustable and assemblable head fixing device |
US11911144B2 (en) | 2017-08-22 | 2024-02-27 | C. R. Bard, Inc. | Ultrasound imaging system and interventional medical device for use therewith |
Families Citing this family (10)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10322269B1 (en) | 2015-01-19 | 2019-06-18 | Dalent, LLC | Dilator device |
US10610308B2 (en) * | 2017-02-01 | 2020-04-07 | Acclarent, Inc. | Navigation guidewire with interlocked coils |
US11612437B2 (en) | 2017-05-10 | 2023-03-28 | Biosense Webster (Israel) Ltd. | Location pad with improved immunity to interference |
US20190070395A1 (en) * | 2017-09-06 | 2019-03-07 | Biosense Webster (Israel) Ltd. | ENT Guidewire with Camera on Tip |
US10685486B2 (en) * | 2018-03-29 | 2020-06-16 | Biosense Webster (Israel) Ltd. | Locating an opening of a body cavity |
US20190374129A1 (en) * | 2018-06-07 | 2019-12-12 | Acclarent, Inc. | Endoscope with integral navigation sensor |
US11484366B2 (en) * | 2018-11-29 | 2022-11-01 | Acclarent, Inc. | Adapter assembly to enable navigation for ENT instruments |
US20200375461A1 (en) * | 2019-05-28 | 2020-12-03 | Biosense Webster (Israel) Ltd. | Flexible brain probe over guidewire |
US20200375492A1 (en) * | 2019-05-28 | 2020-12-03 | Biosense Webster (Israel) Ltd. | Brain signal tracking |
CN110731745A (en) * | 2019-09-10 | 2020-01-31 | 中山大学附属第一医院 | endoscope shape estimation device integrating pressure sensing technology |
Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20060004286A1 (en) * | 2004-04-21 | 2006-01-05 | Acclarent, Inc. | Methods and devices for performing procedures within the ear, nose, throat and paranasal sinuses |
Family Cites Families (42)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JP3135068B2 (en) * | 1994-09-15 | 2001-02-13 | ビジュアリゼイション テクノロジー インコーポレイテッド | Position tracking and image generation system for medical applications using a reference unit fixed to the patient's head |
US5829444A (en) | 1994-09-15 | 1998-11-03 | Visualization Technology, Inc. | Position tracking and imaging system for use in medical applications |
US6151404A (en) | 1995-06-01 | 2000-11-21 | Medical Media Systems | Anatomical visualization system |
US6167296A (en) | 1996-06-28 | 2000-12-26 | The Board Of Trustees Of The Leland Stanford Junior University | Method for volumetric image navigation |
US6016439A (en) | 1996-10-15 | 2000-01-18 | Biosense, Inc. | Method and apparatus for synthetic viewpoint imaging |
US6346940B1 (en) | 1997-02-27 | 2002-02-12 | Kabushiki Kaisha Toshiba | Virtualized endoscope system |
DE69805209T2 (en) | 1998-02-23 | 2002-11-28 | Algotec Systems Ltd | SYSTEM AND METHOD FOR AUTOMATIC ROUTE PLANNING |
US6505065B1 (en) | 1999-10-29 | 2003-01-07 | Koninklijke Philips Electronics, N.V. | Methods and apparatus for planning and executing minimally invasive procedures for in-vivo placement of objects |
US7072501B2 (en) | 2000-11-22 | 2006-07-04 | R2 Technology, Inc. | Graphical user interface for display of anatomical information |
US7822461B2 (en) | 2003-07-11 | 2010-10-26 | Siemens Medical Solutions Usa, Inc. | System and method for endoscopic path planning |
US20060063973A1 (en) | 2004-04-21 | 2006-03-23 | Acclarent, Inc. | Methods and apparatus for treating disorders of the ear, nose and throat |
US8702626B1 (en) | 2004-04-21 | 2014-04-22 | Acclarent, Inc. | Guidewires for performing image guided procedures |
US8894614B2 (en) | 2004-04-21 | 2014-11-25 | Acclarent, Inc. | Devices, systems and methods useable for treating frontal sinusitis |
US9554691B2 (en) | 2004-04-21 | 2017-01-31 | Acclarent, Inc. | Endoscopic methods and devices for transnasal procedures |
US20110004057A1 (en) | 2004-04-21 | 2011-01-06 | Acclarent, Inc. | Systems and methods for transnasal dilation of passageways in the ear, nose or throat |
US7462175B2 (en) | 2004-04-21 | 2008-12-09 | Acclarent, Inc. | Devices, systems and methods for treating disorders of the ear, nose and throat |
US20070208252A1 (en) | 2004-04-21 | 2007-09-06 | Acclarent, Inc. | Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses |
JP4836122B2 (en) | 2006-02-09 | 2011-12-14 | 国立大学法人浜松医科大学 | Surgery support apparatus, method and program |
US8190389B2 (en) | 2006-05-17 | 2012-05-29 | Acclarent, Inc. | Adapter for attaching electromagnetic image guidance components to a medical device |
US20080123910A1 (en) | 2006-09-19 | 2008-05-29 | Bracco Imaging Spa | Method and system for providing accuracy evaluation of image guided surgery |
US9037215B2 (en) | 2007-01-31 | 2015-05-19 | The Penn State Research Foundation | Methods and apparatus for 3D route planning through hollow organs |
WO2008111070A2 (en) | 2007-03-12 | 2008-09-18 | David Tolkowsky | Devices and methods for performing medical procedures in tree-like luminal structures |
US8239003B2 (en) | 2007-04-16 | 2012-08-07 | General Electric Company | System and method of integrating electromagnetic microsensors in guidewires |
US8320711B2 (en) | 2007-12-05 | 2012-11-27 | Biosense Webster, Inc. | Anatomical modeling from a 3-D image and a surface mapping |
US20100198191A1 (en) * | 2007-12-20 | 2010-08-05 | Acclarent, Inc. | Method and system for treating target tissue within the eustachian tube |
US8663120B2 (en) | 2008-04-18 | 2014-03-04 | Regents Of The University Of Minnesota | Method and apparatus for mapping a structure |
ES2700863T3 (en) * | 2008-07-30 | 2019-02-19 | Acclarent Inc | Devices for localization of the paranasal ostium |
US20100030031A1 (en) | 2008-07-30 | 2010-02-04 | Acclarent, Inc. | Swing prism endoscope |
EP2323724A1 (en) * | 2008-09-18 | 2011-05-25 | Acclarent, Inc. | Methods and apparatus for treating disorders of the ear nose and throat |
EP2348954A1 (en) | 2008-10-20 | 2011-08-03 | Koninklijke Philips Electronics N.V. | Image-based localization method and system |
US20100241155A1 (en) | 2009-03-20 | 2010-09-23 | Acclarent, Inc. | Guide system with suction |
US8653785B2 (en) | 2009-03-27 | 2014-02-18 | Qualcomm Incorporated | System and method of managing power at a portable computing device and a portable computing device docking station |
WO2010140074A1 (en) | 2009-06-01 | 2010-12-09 | Koninklijke Philips Electronics N.V. | Distance-based position tracking method and system |
ES2648141T3 (en) * | 2010-09-22 | 2017-12-28 | Acclarent, Inc. | Apparatus for treating sinus disorders |
US9155492B2 (en) * | 2010-09-24 | 2015-10-13 | Acclarent, Inc. | Sinus illumination lightwire device |
US8768029B2 (en) | 2010-10-20 | 2014-07-01 | Medtronic Navigation, Inc. | Selected image acquisition technique to optimize patient model construction |
US8764683B2 (en) * | 2010-12-29 | 2014-07-01 | Mediguide Ltd. | Medical device guidewire with a position sensor |
WO2012131660A1 (en) | 2011-04-01 | 2012-10-04 | Ecole Polytechnique Federale De Lausanne (Epfl) | Robotic system for spinal and other surgeries |
WO2014093880A1 (en) | 2012-12-13 | 2014-06-19 | University Of Washington Through Its Center For Commercialization | Methods and systems for selecting surgical approaches |
US9463307B2 (en) * | 2012-12-21 | 2016-10-11 | Medtronic Xomed, Inc. | Sinus dilation system and method |
US11800991B2 (en) | 2013-08-15 | 2023-10-31 | Intuitive Surgical Operations, Inc. | Graphical user interface for catheter positioning and insertion |
US10772489B2 (en) | 2014-07-09 | 2020-09-15 | Acclarent, Inc. | Guidewire navigation for sinuplasty |
-
2015
- 2015-07-07 US US14/792,823 patent/US10772489B2/en active Active
- 2015-07-08 EP EP15739734.0A patent/EP3166678B1/en active Active
- 2015-07-08 AU AU2015287957A patent/AU2015287957B2/en not_active Ceased
- 2015-07-08 CN CN202110706710.6A patent/CN113476719A/en active Pending
- 2015-07-08 JP JP2017501024A patent/JP6588076B2/en not_active Expired - Fee Related
- 2015-07-08 WO PCT/US2015/039501 patent/WO2016007591A1/en active Application Filing
- 2015-07-08 CA CA2954407A patent/CA2954407A1/en not_active Abandoned
- 2015-07-08 CN CN201580037449.8A patent/CN106488736A/en active Pending
- 2015-07-08 ES ES15739734T patent/ES2751274T3/en active Active
- 2015-07-08 KR KR1020177003221A patent/KR20170035931A/en unknown
-
2016
- 2016-12-27 IL IL249786A patent/IL249786B/en active IP Right Grant
Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20060004286A1 (en) * | 2004-04-21 | 2006-01-05 | Acclarent, Inc. | Methods and devices for performing procedures within the ear, nose, throat and paranasal sinuses |
Cited By (44)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10772489B2 (en) | 2014-07-09 | 2020-09-15 | Acclarent, Inc. | Guidewire navigation for sinuplasty |
US10463242B2 (en) | 2014-07-09 | 2019-11-05 | Acclarent, Inc. | Guidewire navigation for sinuplasty |
US10905396B2 (en) | 2014-11-18 | 2021-02-02 | C. R. Bard, Inc. | Ultrasound imaging system having automatic image presentation |
US11696746B2 (en) | 2014-11-18 | 2023-07-11 | C.R. Bard, Inc. | Ultrasound imaging system having automatic image presentation |
US10646201B2 (en) | 2014-11-18 | 2020-05-12 | C. R. Bard, Inc. | Ultrasound imaging system having automatic image presentation |
US20160372252A1 (en) * | 2015-06-18 | 2016-12-22 | Biosense Webster (Israel) Ltd. | Tracking sensor |
US11031172B2 (en) * | 2015-06-18 | 2021-06-08 | Biosense Webster (Israel) Ltd. | Tracking sensor |
US10188465B2 (en) | 2015-08-26 | 2019-01-29 | Biosense Webster (Israel) Ltd. | Automatic ENT surgery preplanning using a backtracking maze problem solution |
US10492867B2 (en) | 2015-08-26 | 2019-12-03 | Biosense Webster (Israel) Ltd. | Automatic ENT surgery preplanning using a backtracking maze problem solution |
US10722306B2 (en) | 2015-11-17 | 2020-07-28 | Biosense Webster (Israel) Ltd. | System for tracking guidewire with ray tracing capability |
ES2608861A1 (en) * | 2016-06-30 | 2017-04-17 | Universidad De Málaga | Device, system and procedure to obtain computational rhinomanometric curves (Machine-translation by Google Translate, not legally binding) |
CN107684660A (en) * | 2016-08-04 | 2018-02-13 | 韦伯斯特生物官能(以色列)有限公司 | Sacculus positioning in nasal sinus expansion operation |
US11058446B2 (en) | 2016-09-14 | 2021-07-13 | Biosense Webster (Israel) Ltd. | ENT tool antenna |
EP3300679A1 (en) * | 2016-09-14 | 2018-04-04 | Biosense Webster (Israel), Ltd. | Wireless tool for treatment of ear, nose, throat |
EP3315163A1 (en) | 2016-10-25 | 2018-05-02 | Biosense Webster (Israel), Ltd. | Guidewires having improved mechanical strength and electromagnetic shielding |
US10603472B2 (en) | 2016-10-25 | 2020-03-31 | Biosense Webster (Israel) Ltd. | Guidewires having improved mechanical strength and electromagnetic shielding |
JP2018079312A (en) * | 2016-11-01 | 2018-05-24 | バイオセンス・ウエブスター・(イスラエル)・リミテッドBiosense Webster (Israel), Ltd. | Rigid ENT tool |
JP7106263B2 (en) | 2016-11-01 | 2022-07-26 | バイオセンス・ウエブスター・(イスラエル)・リミテッド | Rigid ENT tool |
EP3395282A1 (en) | 2017-04-25 | 2018-10-31 | Biosense Webster (Israel) Ltd. | Endoscopic view of invasive procedures in narrow passages |
US11026747B2 (en) | 2017-04-25 | 2021-06-08 | Biosense Webster (Israel) Ltd. | Endoscopic view of invasive procedures in narrow passages |
US11911144B2 (en) | 2017-08-22 | 2024-02-27 | C. R. Bard, Inc. | Ultrasound imaging system and interventional medical device for use therewith |
US20200054282A1 (en) * | 2018-08-14 | 2020-02-20 | Biosense Webster (Israel) Ltd. | Guidewire with an integrated optical fiber |
EP3632360A1 (en) | 2018-10-04 | 2020-04-08 | Biosense Webster (Israel) Ltd. | Automatic probe reinsertion |
CN112804940A (en) * | 2018-10-04 | 2021-05-14 | 伯恩森斯韦伯斯特(以色列)有限责任公司 | ENT tool using camera |
JP7387383B2 (en) | 2018-10-26 | 2023-11-28 | バイオセンス・ウエブスター・(イスラエル)・リミテッド | robot loose mode |
EP3643265A1 (en) | 2018-10-26 | 2020-04-29 | Biosense Webster (Israel) Ltd. | Loose mode for robot |
US11497566B2 (en) | 2018-10-26 | 2022-11-15 | Biosense Webster (Israel) Ltd. | Loose mode for robot |
JP2020065936A (en) * | 2018-10-26 | 2020-04-30 | バイオセンス・ウエブスター・(イスラエル)・リミテッドBiosense Webster (Israel), Ltd. | Loose mode for robot |
EP3673854A1 (en) | 2018-12-28 | 2020-07-01 | Biosense Webster (Israel) Ltd. | Correcting medical scans |
US11107213B2 (en) | 2018-12-28 | 2021-08-31 | Biosense Webster (Israel) Ltd. | Correcting medical scans |
US11272980B2 (en) | 2019-04-04 | 2022-03-15 | Biosense Webster (Israel) Ltd. | Medical instrument with coagulation |
EP3718497A1 (en) | 2019-04-04 | 2020-10-07 | Biosense Webster (Israel) Ltd. | Medical instrument with coagulation |
EP3718493A1 (en) | 2019-04-04 | 2020-10-07 | Biosense Webster (Israel) Ltd. | Medical instrument identification |
EP3725251A1 (en) | 2019-04-18 | 2020-10-21 | Biosense Webster (Israel) Ltd. | Grasper tool with coagulation |
US11712287B2 (en) | 2019-04-18 | 2023-08-01 | Biosense Webster (Israel) Ltd. | Grasper tool with coagulation |
WO2020234668A1 (en) | 2019-05-23 | 2020-11-26 | Biosense Webster (Israel) Ltd. | Probe with radiopaque tag |
US11589772B2 (en) | 2019-05-23 | 2023-02-28 | Biosense Webster (Israel) Ltd. | Probe with radiopaque tag |
US11883151B2 (en) | 2019-05-23 | 2024-01-30 | Biosense Webster (Israel) Ltd. | Probe with radiopaque tag |
EP3791786A1 (en) | 2019-09-16 | 2021-03-17 | Biosense Webster (Israel) Ltd | Flexible shielded position sensor |
US11344221B2 (en) | 2019-09-16 | 2022-05-31 | Biosense Webster (Israel) Ltd. | Flexible shielded position sensor |
WO2021181209A1 (en) | 2020-03-09 | 2021-09-16 | Biosense Webster (Israel) Ltd. | Finding roll angle of distal end of deflectable or non-deflectable invasive medical instrument |
WO2022003444A1 (en) | 2020-06-29 | 2022-01-06 | Biosense Webster (Israel) Ltd. | Efficient automatic finding of minimal ear-nose-throat (ent) path for probe |
US20220061922A1 (en) * | 2020-08-25 | 2022-03-03 | Acclarent, Inc. | Apparatus and method for posterior nasal nerve ablation |
CN115300130A (en) * | 2022-10-12 | 2022-11-08 | 吉林大学第一医院 | Adjustable and assemblable head fixing device |
Also Published As
Publication number | Publication date |
---|---|
US10772489B2 (en) | 2020-09-15 |
JP6588076B2 (en) | 2019-10-09 |
IL249786A0 (en) | 2017-02-28 |
CA2954407A1 (en) | 2016-01-14 |
JP2017521159A (en) | 2017-08-03 |
CN106488736A (en) | 2017-03-08 |
EP3166678B1 (en) | 2019-08-21 |
WO2016007591A1 (en) | 2016-01-14 |
ES2751274T3 (en) | 2020-03-31 |
EP3166678A1 (en) | 2017-05-17 |
KR20170035931A (en) | 2017-03-31 |
AU2015287957B2 (en) | 2019-08-01 |
AU2015287957A1 (en) | 2017-02-02 |
CN113476719A (en) | 2021-10-08 |
IL249786B (en) | 2020-05-31 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US10772489B2 (en) | Guidewire navigation for sinuplasty | |
US10463242B2 (en) | Guidewire navigation for sinuplasty | |
US11529070B2 (en) | System and methods for guiding a medical instrument | |
EP3367932B1 (en) | System for navigation of surgical instruments | |
US11065061B2 (en) | Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses | |
US7720521B2 (en) | Methods and devices for performing procedures within the ear, nose, throat and paranasal sinuses | |
EP1838378B1 (en) | Apparatus for guiding an instrument to a target in the lung | |
CN112292062A (en) | Endoscope with integrated navigation sensor | |
CN106913332A (en) | Find out position and be orientated so that instrument is visualized | |
EP3315084A1 (en) | Rigid ent tool | |
US20230233097A1 (en) | Customized patient tracker for image guided surgery | |
US20190184142A1 (en) | Guidewire assembly with offset core wires | |
CN116829089A (en) | System for updating a graphical user interface based on intra-operative imaging | |
CN114901155A (en) | Registered lateral view Ultrasound (US) imager via trocar insertion into brain |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AS | Assignment |
Owner name: BIOSENSE WEBSTER (ISRAEL) LTD., ISRAEL Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:GOVARI, ASSAF;KESTEN, RANDY J.;ALTMANN, ANDRES C.;AND OTHERS;SIGNING DATES FROM 20151103 TO 20151109;REEL/FRAME:037021/0566 Owner name: ACCLARENT, INC., CALIFORNIA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:GOVARI, ASSAF;KESTEN, RANDY J.;ALTMANN, ANDRES C.;AND OTHERS;SIGNING DATES FROM 20151103 TO 20151109;REEL/FRAME:037021/0566 |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: FINAL REJECTION MAILED |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: DOCKETED NEW CASE - READY FOR EXAMINATION |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: FINAL REJECTION MAILED |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: DOCKETED NEW CASE - READY FOR EXAMINATION |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: NON FINAL ACTION MAILED |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: RESPONSE TO NON-FINAL OFFICE ACTION ENTERED AND FORWARDED TO EXAMINER |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: NOTICE OF ALLOWANCE MAILED -- APPLICATION RECEIVED IN OFFICE OF PUBLICATIONS |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: NOTICE OF ALLOWANCE MAILED -- APPLICATION RECEIVED IN OFFICE OF PUBLICATIONS |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: PUBLICATIONS -- ISSUE FEE PAYMENT VERIFIED |
|
STCF | Information on status: patent grant |
Free format text: PATENTED CASE |
|
MAFP | Maintenance fee payment |
Free format text: PAYMENT OF MAINTENANCE FEE, 4TH YEAR, LARGE ENTITY (ORIGINAL EVENT CODE: M1551); ENTITY STATUS OF PATENT OWNER: LARGE ENTITY Year of fee payment: 4 |